Getting to the Point

Chronic pain disorders are not always well understood by the medical or psychological community. In an effort to understand, extensive physical examinations, CAT, MRI, X-ray, and laboratory tests are completed in order to find concrete evidence that a real problem exists. Even when the results of these examinations are found to be within normal limits, many patients continue to complain about their pain problems well beyond what most health care providers consider would be appropriate for a particular injury or related problem.

When the Medical Examination Shows No Specific Problem

The focus of medical science and practice has been directed at understanding and treating acute life and death problems. Little attention has been focused on how to handle the long-term chronic problems that people are expected to live with. When patients present with chronic pain, it is easy for many medical practitioners to assign them to the category of psychological overlay since no observable cause can be found for the lingering pain problem. Additionally, by the time chronic pain patients ask for help they are frustrated, angry, depressed, feeling overwhelmed, fatigued, and have poor sleep patterns. Even those patients with identified chronic pain pathology have additional problems, which can be amplified by myofascial soft-tissue problems. These are often caused by how patients stand, brace, and protect their bodies from pain, and from underlying structural irritations that cause muscles to tighten and become tense. This causes much frustration and confusion for patients and providers.

Crisis intervention theory suggests that when people are under stress they tend to psychologically regress thus resulting in the person looking sicker than may be the actual case. Such regressions make it easier for medical professionals to also feel frustrated by not knowing how to provide curative services to this difficult population of patients. This creates a unique tension between providers and patients, each searching for an answer that will resolve the problem.

Mental health professionals are frequently enlisted to search for the psychological causes, which allow for the chronic patient to be dismissed and discredited. This leads to a mistaken belief that chronic pain/problem patients are difficult, if not impossible, to treat. There is also a belief that such patients are only trying to milk the system of compensation in some way and, therefore, every effort must be made to find reasons to avoid dealing with such patients as soon as possible. This belief also extends to the idea that once the patient is diagnosed as having a functional (psychological) overlay, he or she will magically resolve the pain problem once the case is closed. Though there are some patients for whom this may be true, this approach tends to complicate the issues of how to provide an effective pain management treatment approach, which allows patients to start to feel in control of their lives again through an active self-care approach.

Pain management psychologists have long been active in developing such approaches that can be quite effective. A cognitive behavioral pain management approach, which helps to educate the patient about active skills, offers some of these alternatives. However, to be fully effective, health care professionals need to consider the importance of helping patients with a myofascial soft-tissue approach to self-care.

Myofascial Disorders as the Underlying Cause

In their book, Myofascial Pain Dysfunction: A Trigger Point Therapy Manual (Vol. 1 & 2), Janet Travell, MD, and David Simons, MD, were some of the first clinicians to utilize information that was first understood in osteopathic medicine approaches emphasizing the importance of the muscle system to body balance. More recently, Davin Starlanyl, MD, and Mary Ellen Copeland, MS, MA, published Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual (New Harbinger Publications, Inc., 1996), offering more research. Both books describe muscle “trigger points" as tender points that form in the muscles for any reason — injuries, stress, chronic pressure, accidents, etc. Trigger points are also known as jump points because when pressure is applied to them the person wants to jump. As trigger points are formed they cause other muscles to compensate thereby creating additional trigger points. These trigger points are not permanent and can be reversed with proper trigger point therapy. However, this requires active participation of the patient. Patients also need to be taught how to do their own trigger point therapy because their muscles will have developed habits and want to return to being tight and tender. Patients have to do regular trigger point therapy at home on a frequent basis until they have knocked out the trigger points, stretched their muscles to their normal length and flexibility, and a new habit pattern is formed for the muscles.

Pain management psychologists have long been active in developing such approaches that can be quite effective.

Treatment Options Acupressure/Trigger Point Self-Care Therapy

Acupressure techniques can be used to unblock oxygen and blood flow until the trigger point releases and the muscle can be stretched to its normal length again. Pressure is placed on the trigger point causing pain that is usually intense in nature. Pressure is maintained (up to minute or more) until the trigger point can let go. Patients can find their trigger points when they hit a tender point and feel pain. When a tender point has pressure applied to it and the pain radiates to another area, a myofascial trigger point is found. When pressure is applied to a tender point and the pain does not radiate to another area a tight muscle is found. Though the initial response by the patient is to feel intense pain, this quickly subsides as the patient feels the trigger point releasing. The patient also ultimately feels an improvement in muscle flexibility, length, and a reduction of pain.

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